Gastroeneterlogy Flashcards
Define diarrhoea
Increased frequency due to increased water content of stools
Define steatorrhoea
Pale, yellow/white stools that do not easily flush due to increased fat content of stools.
Fecal urgency suggests ____ pathology
Rectal
Differential diagnosis for diarrhoea
Classify accoring to features and cause
A) Gastrointestinal causes
- Acute onset
- Suspect gastroenteritis
- Chronic onset
- Alternating with constipation - IBS
- With wt loss, anorexia, nocturnal - think organic cause
- Blooody diarrhoea
- Vascular - ischaemic colitis
- Infective - CHEST + C.dif
- Inflammatory - IBD
- Neoplastic - polyps, CRC
- Mucus diarrhoea
- Inflammatory - IBD
- Neoplatic - Polyps, CRC
- Purulent diarrhoea
- Diverticulitis, abscess
Other causes:
- Associated with disease
- Hyperthyroidism
- Autonomic neuropathy
- Carcinoid
- iatrogenic - drug
- PPIs, cimentidine
- Abx
- NSAIDs
- Digoxin
General management of diarrhoea
- Treat the cause
- Oral or IV hydration
- Codeine phosphate or loperamide after each loose steal
- Abx if needed
- Anti-emetics if needed - prochlorperazine
Common infective causes of bloody diarrhoea
CHESS + pseudomembranous colitis
- C - campylobater
- H - haemorrhoagic E. Coli
- S - salmonella
- S - shigella
- C. Diff
The C. Diff pathogen
Gram +ve spore forming anerobe
Produces enterotoxin A and B
Spores can survive for more than 40 days
Tha main causative organism of abx assocaited dirrhoea is ____ and acconunts for ____ % of cases
C. Diff.
25%
Tha main causative organism of psudomembranous collitis is ____ and acconunts for ____ % of cases
C. Diff
100%
Risk factors for C. Diff
- Antibiotic use - up to 2 months post use
- PPIs
- Prolonged hispital stay with c.diff contact
- increased age
Clinical presentation of C.Dif gastroeneterologicla infection
Disease spectrum
- Asymtomatic
- Diarrhoea
- Colitis withour pseudomebranes
- Pseudomembranous colitis
- Fulminant colitis
What is pseudomembranous colitis?
Inflammation of the colon secondary to C. Diff infection.
Presents as:
- Systemic symtoms: fever and dehydration
- Abdo pain, blood diarrhoea and mucus PR
Pseudomembranes (yellow plaques) are visualised on flexi sig
What are the complications of pseudomembranous colitis
- toxic megacolon
- Toxic dilataion with perforation
- Multiorgan failure
Severe C.Dif infection would be classified as
Having one or more of the following:
- WCC > 14
- Cr >50% of baseline
- Temp >38.5
- Features of severecolitis clinically or radiologically
Management of C.Diff
- IV/PO hydration
- Avoid opioids/antidiarrhoeals
- Enteic precautions
- Stop abx
- Start abx:
- Metronidazole 400mg TDS PO for 10-14 days
- Second line or if very severe: Vancomycin 125mg QDS PO for 10-14 days
- If no response, double dose. Double again to max (500mg) if still no reposne.
- Urgent coelctomy if: toxic megacolon, increasing LDH or deteriorating condition.
7.
There is a ____% relapse following c.diff treatment. THis is further treated with?
15-30%
With a repeat course of metro 10-14 days.
Vanc if further relapses (25%)
Defintion of constipation
Constipation is defined as infrequent stool (3 or less a week) or a decrease from the norm, or associated with difficulty, straining or pain.
Causes of constipation
OPENED IT
- O - obstruction
- Mechanical -
- Luminal - cancer, adhesions, inflammatory stricutres
- Extraluminal - hernia, cancer, pelvic mass
- Pseudo-obstruction - post op illeus
- Mechanical -
- P - Pain in the Perineal area:
- Proctalgia fugax
- Anal fissures
- E - endocrine and metabolic (electrolytes)
- Low T4
- Low Ca, low K, uraemia
- N - neuro
- MS
- Cauda equina
- Myelopathy
- E - elderly
- D - diet/dehydration
- I - IBS
- T - toxins - Opioids and anti-muscarinins
management of constipation
- Conservative:
- hydrate and dietary modification
- Tx the cause
- Medical:
- Laxatives:
- Oral, Enemas or Suppositories
- Types:
- Osmotic - when others have failed
- Bulk forming - take a few days to work
- Stimulants - 6-12 hours to act
- Softeners - for rectal/anal pain
- Laxatives:
- Surgical - manual evacuation - very rarely done.
Name three bulk-forming laxatives
- Fibogel (ispaghula husk)
- Bran
- Methylcellulose
Name three stimulant laxatives
- Senna
- Docusate sodium
- Bisacodyl (PO or PR)
Name three osmotic laxatives
- Movicol
- Lactulose
- MgSO4 for rapid action
Give an example of an enema and a suppository used in constipation
Enema: phosphate enema (osmotic)
Suppository: glycerol (stimulant)
Defintion of IBS
Irritable bowel syndrome is a disorder of enhanced viscerla perception. It is bowel symtoms without an identifiable organic cause.
Clincal features of IBS
IBS features are outlined in the ROME diagnositc criteria:
- abdominal pain or discomfort for at least 12 weeks with at least two of the following features (“IBS”):
- Increased or decreased frequency
- Better on passing stool
- Shape or form changes: pellets, mucus…
- Additonally two of the following:
- Mucus PR
- Urgency
- Bloating/distention
- Incoplete evacuation
- Worsening after food
Managment of IBS
- Conservative:
- Dietary modification and trails of exclusion diets
- Medical:
- To treat symtoms:
- Bulking agents for constipation and diarrhoea: fybogel
- Antispasmodics for pain and bloating: mebevirine
- To treat IBS:
- Amitryptyline
- CBT
- To treat symtoms:
Causes of dysphagia
- Inflammation
- Apathous ulcers
- Oral candidiasis
- Tonsilits
- Pharyngitis
- Oesophagitis: GORD and candida
- Obstruction
- Luminal - FB or food bolus
- Mural
- Bening stricture
- Plummer-Vinson
- Oesophagitis
- Trauma
- Malignant stricture:Pharynx, oesophagus, gastric.
- Pharangeal pouch
- Bening stricture
- Extra-mural
- Lung cancer, mediastinal LNs
- Thoracic aortic aneurysm
- Substernal goitre
- Rolling hiatus hernia
- Motility
- Local:
- Pseudobulbular/bulbular palsy
- Achalasia
- Diffuse oesophageal spasm
- Nutcracker syndrom
- General: CREST/scleroderma, MG
- Local:
Causes of dysphagia
Intial dyspahgia to solids, then liquids suggests?
Stricutre
Causes of dysphagia
Dyspahgia to solids AND liquids from the start suggests?
Motility disorder